Sales Customer Information Sheet - PDF

Document Sample
Sales Customer Information Sheet - PDF Powered By Docstoc
					                           New Customer Information Sheet


In order to generate an account number for you the first page of our combination New Customer
Information Sheet/Credit Application must be completed. Please indicate under the Terms of Sale if
you will be paying by check in advance or by credit card (see Credit Card Authorization Form). An
owner or corporate officer’s signature is required under the terms of sale.

Be assured that this is not an application for credit, simply a tool for expediting current and future
orders. If you would like to apply for credit please read the Credit Application cover sheet.

Please complete this form and fax it back to 920/684-4344 at your earliest convenience.

Your order cannot be processed until this paperwork has been returned to us.

If you have any questions please do not hesitate to call.

Thank you,

Extrutech Plastics




     5902 West Custer Street – Manitowoc, WI 54220 – Phone 920/684-9650 – Fax 920/684-4344
               www.epiplastics.com – email: extrutech@lakefield.net – 888/818-0118
                              NEW CUSTOMER INFORMATION SHEET / CREDIT APPLICATION
Please complete the information below and return this sheet to us via FAX at 920/684-4344. We must have this New Customer
Information page completed in order to establish your business account number and process your order. If applying for credit,
complete the second page as well.
Primary Business Type:          Operator _____ Dealer _____ Contractor _____ Other _____  Sales Rep. & Code______________________________
                                New Account __________     Reactivation __________ Change of Terms __________ 191 ____192 ____ 193____ 194 ____

Billing Address                                                                        Shipping Address (If different from Billing Address)

Firm Name _____________________________________________________                        Firm Name _____________________________________________________

DBA __________________________________________________________                         DBA __________________________________________________________

Address ________________________________________________________ Address ________________________________________________________

City/State ______________________________________________________ City/State ______________________________________________________

Zip __________________________           County _________________________              Zip __________________________            County _________________________

Email _________________________________________________________                        Email __________________________________________________________

Phone _________________________________________________________ Phone __________________________________________________________

Fax ____________________________________________________________ Fax ____________________________________________________________


                                                              Terms of Sale / Credit Policy
                             Terms of Sale must be signed. If applying for credit, please sign this section and complete page two
                                       PAYMENT TERMS: ____ Net 30 Days ____ Credit Card ____ Check In Advance

1. All invoices are due for payment 30 days after invoice.
2. Past due balances are assessed a finance charge of 1 _% per month which is equal to an annual percentage rate of 18% or the maximum rate authorized
   by law, whichever is lowest. Any past due accounts will be placed on credit hold.
3. Non-current accounts may be placed on a pre-pay basis at our option.
4. In the event any account is not paid when due and that legal action is commenced, the prevailing party shall be entitled to its reasonable attorney fees and
   court costs, including any cost of appeal. Parties hereby agree that if any suit or action is brought to enforce any part of terms of sale herein, venue of said
   suit should be in the District Court of the State of Florida.
5. Signature by you or your authorized representative on this application is presumed to establish your acceptance of the terms and conditions set forth herein,
   without exception, and to your agreement to comply with said terms.
6. It is expressly agreed that at the sole discretion of EPI, if this account is delinquent and is referred to a third party or parties for collection, all additional costs
   will be borne by the signee.
7. Personal credit may be checked as part of credit investigation.

I hereby certify, to the best of my knowledge, that the information submitted for the purpose of securing an account with EPI, and credit, if requested, is true and
accurate. I agree as a condition of the extension of credit to pay all invoices within the terms set forth by EPI, in their credit policy/terms of sale.
I hereby authorize the release of any information necessary to assist in establishing a line of credit with EPI.

***Signed ________________________________________ Title ____________________________

***Print Name ______________________________________ Date ____________________________
                                                                           Certificate of Resale

I hereby certify, that I hold a valid sales tax number ____________________________, issued pursuant to the sales tax law; that I am engaged in the business
of selling tangible personal property described herein, which I shall purchase from EPI and will be resold by me in the form of tangible personal property;
PROVIDED, however, that in the event of any of such property is used for any purpose other than retention, demonstration, or display while holding it for sale in
the regular course of business, it is understood that I am required by the Sales and Use Tax Law to report and pay for the tax, measured by the purchase of
such property. Description of property to be purchased: extruded plastic materials and products.

Signed __________________________________ Date___________________________

Office Use Only:     Approved by: ______________________________________                         TRW _____ D & B _____

Account Number__________________                Entered By_______________________________________                   Date ___________________
CREDIT APPLICATION – PAGE 2

All of the following information must be completed. If a Partnership, please attach information for all partners. If a
Corporation, please provide ownership names and titles.

Sole Proprietorship _____         Partnership _____ Corporation _____            Business is Owned ______ Rented ______
                                  (If Partnership, complete information for all owners)

Owner/Representative ________________________________________Title ______________________________

Driver’s License #_______________________________Social Security #___________________________________

Home Address _______________________________________Home Phone _______________________________

City/State _______________________________________________ Zip __________________________________

Approximate annual sales volume $ ___________     Years in Business __________   Years at Present Location__________

Trade References (bank plus four trades):

Bank/Financial Institution

Account Number/s_______________________         _______________________

Bank or Financial Institution Name ___________________________________________________________________________________________

Address ______________________________________________________________________________

City/State/Zip ______________________________________________________________________________

Phone__________________________________                 Fax__________________________________


Trade References (Four Required)

Company Name ________________________________________ Company Name _____________________________________________________

Address ______________________________________________          Address ___________________________________________________________

City/State ____________________________________________        City/State _________________________________________________________

Zip ______________           Acct. No. _____________________    Zip ______________           Acct. No. _____________________

Contact Name _________________________________________          Contact Name ______________________________________________________

Phone _______________________________________________           Phone ____________________________________________________________

Fax _________________________________________________           Fax ______________________________________________________________



Company Name ________________________________________ Company Name _____________________________________________________

Address ______________________________________________          Address ___________________________________________________________

City/State ____________________________________________        City/State _________________________________________________________

Zip ______________           Acct. No. _____________________    Zip ______________           Acct. No. _____________________

Contact Name _________________________________________          Contact Name ______________________________________________________

Phone _______________________________________________           Phone ____________________________________________________________

Fax _________________________________________________           Fax ______________________________________________________________




                     5902 West Custer Street – Manitowoc, WI 54220 – Phone 920/684-9650 – Fax 920/684-4344
                               www.epiplastics.com – email: extrutech@lakefield.net – 888/818-0118

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:49
posted:7/30/2011
language:English
pages:3
Description: Sales Customer Information Sheet document sample